Neoadjuvant Chemoradiotherapy and Liver Transplantation for Unresectable Hilar Cholangiocarcinoma: The Irish Experience of the Mayo Protocol
| Autor: | Donal Maguire, Justin Geoghegan, Helen M. Heneghan, Thomas F. Gallagher, Emir Hoti, Anthony T Stafford, Alexandra Zaborowski, Barbara Fiore |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Neoplasm Residual Time Factors Databases Factual medicine.medical_treatment 030230 surgery Liver transplantation Primary sclerosing cholangitis Young Adult 03 medical and health sciences 0302 clinical medicine Risk Factors Humans Medicine In patient Hospital Mortality Prospective Studies Young adult Prospective cohort study Aged Transplantation business.industry Multimodal therapy Chemoradiotherapy Middle Aged medicine.disease Neoadjuvant Therapy Liver Transplantation Surgery Treatment Outcome Bile Duct Neoplasms Female 030211 gastroenterology & hepatology Neoplasm Recurrence Local business Ireland Klatskin Tumor Neoadjuvant chemoradiotherapy |
| Zdroj: | Transplantation. 104:2097-2104 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000003114 |
| Popis: | BACKGROUND Pioneered by the Mayo Clinic, multimodal therapy with neoadjuvant chemoradiotherapy and orthotopic liver transplant has emerged as a promising option for unresectable hilar cholangiocarcinoma (hCCA). This study reports the experience of the Irish National Liver Transplant Programme with the Mayo Protocol. METHODS All patients diagnosed with unresectable hCCA between 2004 and 2016, who were eligible for the treatment protocol, were prospectively studied. RESULTS Thirty-seven patients commenced chemoradiotherapy. Of those, 11 were excluded due to disease progression and 26 proceeded to liver transplantation. There were 24 males, the median age was 49, and 88% had underlying primary sclerosing cholangitis. R0 and pathologic complete response rates were 96% and 62%, respectively. Overall median survival was 53 months and 1-, 3-, and 5-year survival was 81%, 69%, and 55%, respectively. The median survival of patients achieving a pathologic complete response was 83.8 months compared with 20.9 months in the group with residual disease (P = 0.036). Six patients (23%) developed disease recurrence. Among the patients who developed metastatic disease during neoadjuvant treatment, median survival was 10.5 months compared with 53 months in patients who proceeded to transplant (P < 0.001). CONCLUSIONS Neoadjuvant chemoradiotherapy followed by liver transplantation substantially increases the survival of patients with unresectable hCCA. Achieving a pathologic complete response confers a significant survival benefit. |
| Databáze: | OpenAIRE |
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